How to Optimize Return to Sport in ACL Surgery

Anterior cruciate ligament (ACL) rupture is one of the most common sport injuries. The incidence of ACL rupture was estimated to range from 30 to 78 per 100.000 person-years. Several sport contact injuries were reported that highly associated with ACL rupture, such as football (15%) and soccer (5.2%) competition. ACL rupture was also found more common in male than female players. The anatomy of ACL originates from lateral wall of the intercondylar fossa and inserts to the tibial eminence anteriorly. It comprises of two bundles, such as anteromedial and posterolateral bundle. The femoral attachment arises from resident’s ridge to the posterior articular margin of the lateral femoral condyle. The tibial attachment is closely related to the attachment of the lateral meniscus. Return to sport (RTS) remains to be the main goal of ACL reconstruction (ACLR). However, RTS criteria remains debatable due to differences outcome measure. RTS was noted 60-80% in different sports following ACL reconstruction surgery. However, there was several factors that may affect the ACLR surgery. Concomitant ligamentous and meniscus injury may prolong the RTS. Graft choice may also contribute to the process of RTS. Bone-patellar-tendon-bone (BPTB) graft has shown to have early incorporation to the femoral and tibial tunnel due to bone-to-bone healing. Surgical technique also plays role in the early RTS. Single-bundle and double-bundle ACL reconstruction remains debatable in ACLR surgery. However, there was no differences in both surgical techniques in terms of early RTS.